Variations in decision making for seriously ill hospitalized patients among institutions

2003 Fiscal Year Final Research Report Summary

• Project/Area Number: 14572130
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Medical sociology
• Research Institution: Yamaguchi University
• Principal Investigator: KUNIHIRO Mitsuru Yamaguchi Univ., Hospital, Research Associate, 医学部附属病院, 助手 (40284252)
• Co-Investigator(Kenkyū-buntansha): SAKABE Takefumi Yamaguchi Univ., School of Medicine, Professor, 医学部, 教授 (40035225) ; SOEJIMA Yoshiyuki Yamaguchi Univ., Hospital, Assistant Professor, 医学部附属病院, 講師 (20206676) ; FUKUMOTO Youhei Yamaguchi Univ., Hospital, Professor, 医学部附属病院, 教授 (90136193) ; YAMASE Hiroaki Yamaguchi Univ., School of Medicine, Associate Professor, 医学部, 助教授 (90279357) ; INOUE Yuuji Yamaguchi Univ., Hospital, Professor, 医学部附属病院, 教授 (80213180)
• Project Period (FY): 2002 – 2003
• Keywords: Severity of illness index / Outcome prediction / Medical futility

Research Abstract

We developed scoring program to assess variations in decision making for seriously ill hospitalized patients among institutions. We employed APACHE-II system for evaluation at the initiation of ICU treatment. The APACHE-II scores were calculated automatically with physiological variables and laboratory tests. We modified the program to enable trend analysis of daily APACHE II scores. To evaluate the variations in decision making among institutions, we categorized institutions to 3 groups according to types of ICU settings, Closed-ICU, ER-ICU, and Open-ICU
ICU of Yamaguchi university hospital is a 14-bed unit staffed by S attending physicians, categorized to Closed-ICU. During study period, there ware 1007 admissions to this ICU, and mean ICU length of stay was 5.2 days. Thirty-nine patients died in ICU, including 5 respiratory distress, 12 heart failure, 13 MOF, 3 CNS dysfunction, and 6 others. Twenty-nine patients were predicted to die refereed from APACHE-II trend analysis. Withholding of intensive care were applied in 18 patients. Except one patient discharge from hospital alive, mean duration from withholding to death were 3.2 days
Refer to Closed-ICU, withholding of intensive care in ER-ICU were applied earlier. In Open-ICU setting, some seriously ill patient had no precise decision making of withholding. Difference of reasons for initiating intensive care and of physician staffing for critical care influenced the variations in decision making for seriously ill hospitalized patients among institutions